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Samenvatting International Public Health
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The Principles and Goals of Global HealthOne reason to study global health is to gain a better understanding of the progress made so far in addressing
global health problems. Another reason to study global health, however, is to better understand the most
important global health challenges that remain and learn how to address them rapidly, effectively, efficiently
and fairly.
Health, Public Health, and Global Health
The World Health Organization (WHO) set out a broad definition of health in 1948 that is still widely used:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.” C.E.A. Winslow, considered to be the founder of modern public health in the United States,
formulated a definition of public health in 1923 that is still commonly used today: “The science and the art of
preventing disease, prolonging life, and promoting physical health and mental health and efficiency through
organized community efforts toward a sanitary environment, the control of community infections, the
education of the individual in principles of personal hygiene, the organization of medical and nursing service
for the early diagnosis and treatment of disease and the development of the social machinery to ensure to
every individual in the community a standard of living adequate for the maintenance of health.” Many people
confuse “public health” and “medicine,” although they have quite different approaches. The biggest
difference between the medical approach and the public health approach is the focus in public health on the
health of populations rather than on the health of individuals. Exaggerating somewhat for effect, we could
say, for example, that a physician cares for an individual patient whom he or she immunizes against a
particular disease, whereas a public health specialist is likely to focus on how one ensures that the whole
community gets vaccinated. Examples of public health activities are:
The promotion of hand washing
The promotion of bicycle and motorcycle helmets
The promotion of knowledge about HIV/AIDS
Large-scale screening for diabetes and hypertension
Large-scale screening of the eyesight of schoolchildren
Mass dosing of children against worms
The operation of a supplementary feeding program for poorly nourished young children
The taxation of tobacco and alcohol
The regulation of industrial pollution
The regulation of food labeling
The U.S. Institute of Medicine defined global health as “health problems, issues, and concerns that transcend
national boundaries and may best be addressed by cooperative actions.” Another group defined what we
would now call global health as “the application of the principles of public health to health problems and
challenges that transcend national boundaries and to the complex array of global and local forces that affect
them.”
One Health and Planetary Health
The American Veterinary Medical Foundation defined One Health as follows: “The integrative effort of
multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and
the environment.” A related concept is referred to as Planetary Health. A report of a commission of the
Rockefeller Foundation and The Lancet noted the following: “Planetary health is the achievement of the
highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the
human systems—political, economic, and social—that shape the future of humanity and the Earth’s natural
,systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary
health is the health of human civilization and the state of the natural systems on which it depends.” It may be
helpful to think of One Health as focusing on the interconnectedness of animal, human, and environmental
health, whereas Planetary Health has a greater focus on the health of the environment and the connections
between that and human and animal well-being.
Critical Global Health Concepts
In order to understand and help address key global health issues, there are several concepts with which one
must be familiar. Some of the most important include the following:
The determinants and social determinants of health
The key risk factors for different health conditions
The global burden of disease
The measurement of health status
The demographic and epidemiologic transitions
The organization and functions of health systems
Links among health, education, development, poverty, and equity
Building on these concepts, those interested in global health also need to understand how key health issues,
such as the following, affect different parts of the world and the world as a whole:
Environmental health
Nutrition
Reproductive health
The health of children, adolescents, and young adults
Communicable diseases
Non-communicable diseases
Injuries
Finally, it is important to understand global health issues that are generally addressed through cooperation.
Some of these concern conflicts, natural disasters, and humanitarian emergencies. Others relate to the
mechanisms by which different actors in global health activities work together to solve global health
problems.
The Sustainable Development Goals
The 17 Sustainable Development Goals (SDGs) were formulated by the global community in 2015 as part of
the 2030 Agenda for Sustainable Development:
,
, In addition, it is easy to see how all the goals have an important, even if indirect, relationship with the
achievement of good health and well-being.
The Global Burden of Disease
Measuring the Burden of Disease
Those who work on global health have attempted for several years to construct a single indicator that could
be used to compare how far different countries are from the state of good health. Ideally, such an index
would take account of morbidity, mortality and disability. This index would allow to calculate the index by
age, gender and region. It would also allow one to make comparisons of health status across regions within a
country and across countries. This kind of index would measure what is generally referred to as the burden
of disease. This can also be seen as “the equivalent number of years in full health that a newborn can expect
to live, based on current rates of ill health and mortality.” To calculate HALE, the years of ill health are
weighted according to severity and subtracted from the overall life expectancy. The composite indicator of
health status that is most used in global health work is called the disability-adjusted life year, or DALY. In the
simplest terms, a DALY is “the sum of years lost due to premature death (YLLs) and years lived with disability
(YLDs). DALYs are also defined as “years of healthy life lost”. The calculation of years lost to premature death
is based on the difference between the age at which one dies and one’s life expectancy at that age. To make
this calculation, those involved in the key studies on the global burden of disease have constructed a
reference standard life table that takes account of the highest life expectancy at birth globally. The value for
years lived with disability is calculated by weighting these years by a disability index.
Years of Life Lost (YLL) Years of Life Lived with Disability (YLD)
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